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Nishi-Tokyo-shi, Japan

Yamamoto K.,University of Tokyo | Goto H.,Fukujuji Hospital | Hirao K.,Tokyo Medical and Dental University | Nakajima A.,Tokyo Metropolitan Police Hospital | And 4 more authors.
Journal of Rheumatology | Year: 2015

Objective. To evaluate the longterm safety of tocilizumab (TCZ) for the treatment of rheumatoid arthritis (RA) in a real-world clinical setting in Japan. Methods. In this longterm extension of a single-arm, observational postmarketing surveillance study, a total of 5573 patients who initiated intravenous TCZ between April 2008 and July 2009 were observed for 3 years, regardless of its continuation, for incidence of fatal events, serious infections, malignancy, gastrointestinal perforations, and serious cardiac dysfunction. Results. Of the 5573 patients who were enrolled, 4527 patients (81.23%) completed 3 years of followup. There were no increases in the proportions of patients with fatal events, serious infection, malignancy, GI perforation, or serious cardiac dysfunction over 3 years. The all-cause mortality rate during followup was 2.58% (0.95/100 patient-yrs), and the standardized mortality ratio was 1.27 (95% CI, 1.08 to 1.50). Patients who were older with longer disease duration and respiratory comorbidities were more likely to discontinue TCZ treatment following serious infection during the first year. Among patients who completed 3 years of TCZ treatment, serious infection developed at a constant rate during the 3-year treatment period. The proportion of malignancy during followup was 2.24% (0.83/100 patient-yrs), and the standardized incidence ratio was 0.79 (95% CI, 0.66 to 0.95). Conclusion. The safety profile of TCZ was consistent over time regarding mortality, serious infections, malignancy, gastrointestinal perforation, and serious cardiac dysfunction. These data confirm the longterm safety of TCZ use in patients with RA in a real-world clinical setting. © 2015 The Journal of Rheumatology. All rights reserved.


Kohno M.,Tokyo Metropolitan Police Hospital
Japanese Journal of Neurosurgery | Year: 2012

The anterior transpetrosal approach is a skull base approach that is used for treating lesions in the cerebellopontine angle or pre-pontine area. Trigeminal schwannomas and tentorial meningiomas extending to the Meckel’s cave are good indications for this surgical approach. This approach is also applicable for basilar trunk aneurysms and pontine cavernomas or gliomas. The weak points of this approach are a narrow and deep operative field, the necessity of temporal lobe retraction, and a limited lesion site for manipulation this surgical approach is not appropriate for lesions located around the lower cranial nerves. . Complications such as temporal lobe problems are concerns for surgeons during this procedure therefore, lumbar drainage and or controlling brain retractors are recommended for preventing these difficulties. Given that performance of the anterior transpetrosal approach requires skillful skull base techniques and mastery of methods to prevent complications, this surgical approach is not considered easy. Therefore, surgeons who perform this approach must have adequate knowledge of surgical anatomy so as not to be disoriented during surgerythey must also be aware of potential complications and how to avoid them. © 2012, Japanese Congress of Neurological Surgeons. All rights reserved.


Ebisawa T.,Tokyo Metropolitan Police Hospital
Molecular Genetics and Genomics | Year: 2013

Genetic studies have revealed several clock gene variations/mutations involved in the manifestation of sleep disorders or interindividual differences in sleep-wake patterns, but only part of the genetic risk can be explained by the gene variations/mutations identified to date. Recent progress in research into circadian rhythm generation has provided efficient tools for eliciting the molecular basis of clock-relevant sleep disorders, complementing traditional genetic analysis. While the human master clock resides in the suprachiasmatic nucleus of the hypothalamus (central clock), peripheral tissue cells also generate self-sustained circadian oscillations of clock gene expression (peripheral clock), enabling estimation of individual human clock properties through a single collection of skin fibroblasts or venous blood cells. Some of the established cell lines exhibit autonomous circadian oscillations of clock gene expression, and introduction of clock gene variations into these cell lines by gene targeting makes it possible to investigate changes in the circadian phenotype induced by these variations/mutations without the need for generating transgenic animals. Estimation of human clock properties using peripheral tissue cells, in addition to genetic analysis, will facilitate comprehensive explication of the genetic risk of a variety of disorders relevant to biological clock disturbances, including sleep disorders, mood disorders, and metabolic diseases. © 2013 Springer-Verlag Berlin Heidelberg.


Hagiwara A.,Tokyo Metropolitan Police Hospital
Japanese Journal of Clinical Radiology | Year: 2015

The case is a 39 year old male who presented with discomfort in epigastric area to a primary care physician. A retroperitoneal tumor with arborizing calcification was found incidentally on an abdominal CT. He underwent a surgery with preoperative diagnosis of hyaline vascular type Castleman's disease and it was confirmed pathologically. The presence of arborizing calcification can be helpful to the correct diagnosis of hyaline vascular type Castleman's disease. We report this case with review of literatures.


Sakata R.,University of Tokyo | Aihara M.,University of Tokyo | Murata H.,University of Tokyo | Saito H.,Kanto Central Hospital | And 3 more authors.
Investigative Ophthalmology and Visual Science | Year: 2013

PURPOSE. We investigated the correlation between 24-hour IOP in the habitual (sitting during day and supine during night) position (H24h-IOP) and IOP after a postural-change test (PCTIOP) and a water-drinking test (WDT-IOP). We also investigated ocular and systemic factors related with them in patients with normal tension glaucoma (NTG). METHODS. Japanese NTG patients underwent H24h-IOP, PCT-IOP, and WDT-IOP measurements during a 24-hour period. Correlations among H24h-IOP, PCT-IOP, and WDT-IOP, and contributing ocular/systemic factors were investigated using regression analysis. RESULTS. There were 33 patients included. Peak H24h-IOP correlated positively with peak PCT IOP and peak WDT-IOP (estimate = 0.422 and 0.419, P ≤ 0.010), and peak PCT-IOP with WDT-IOP (0.44, P = 0.002). Peak H24h-IOP correlated with refraction (0.36, P = 0.048) and negatively with the mean deviation (MD, -0.066, P = 0.031). MD and baseline IOP (the mean of H24h-IOP) correlated negatively with the H24h-IOP fluctuation (-0.058 and -0.58, P ≤ 0.050). Refraction, baseline IOP, mean blood pressure (mBP), and body mass index (BMI) correlated with peak PCT-IOP (0.23, 0.52, 0.097, and 0.32, respectively, P ≤ 0.038). PCT-IOP difference correlated with refraction and mBP (0.31 and 0.093, P ≤ 0.016) and negatively with age (-0.069, P = 0.003). Central corneal thickness, baseline IOP, age, and BMI correlated with peak WDT-IOP (0.030, 0.40, 0.088, and 0.26, P ≤ 0.050). Age and BMI correlated with WDT-IOP difference (0.086 and 0.20, P < 0.032). CONCLUSIONS. Positive correlation was found among the peaks of H24h-, PCT-, and WDT-IOP. A worse visual field was associated with higher peak and greater fluctuation of H24h-IOP in NTG. Several ocular/systemic factors were important in interpreting H24h-, PCT-, and WDTIOP. © 2013 The Association for Research in Vision and Ophthalmology, Inc.

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